This process is exacerbated by the collapse of the antioxidant defense system: obesity - related KEAP1 accumulation inhibits NRF2, resulting in a 60% decrease in the expression of GPX4 (p < 0.01), while adipocyte - derived exosomal miR - 34a degrades FSP1, weakening the antioxidant regeneration ability of CoQ10 (Doll et al., 2019; Sun et al., 2015a). Here, GPX4 is linked to obesity due to melanocortin 4 receptor deficiency.